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Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted?
Arash Safavi1, Paul Beaudry, Douglas Jamieson
1Department of Pediatric Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada V6h 3V4.
Insights
Blunt splenic and liver trauma in children can cause pseudoaneurysms. High-grade injuries increase risk, suggesting routine screening before discharge may prevent serious bleeding.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Vascular Imaging
Background:
- Blunt splenic and liver injuries can lead to pseudoaneurysms.
- Current guidelines lack recommendations for follow-up imaging.
- Clinical implications and management of traumatic pseudoaneurysms are debated.
Purpose of the Study:
- To evaluate the incidence and outcomes of pseudoaneurysms in children with blunt liver and spleen trauma.
- To determine the association between injury grade and pseudoaneurysm formation.
- To assess the need for routine screening in high-risk pediatric trauma patients.
Main Methods:
- Retrospective review of pediatric patients (1991-2008) with isolated blunt liver/spleen trauma.
- Analysis of patient demographics, injury grade, and Doppler ultrasound follow-up.
- Comparison of outcomes including spontaneous thrombosis, embolization, and surgical intervention.
Main Results:
- 10 of 186 splenic injuries (5.4%) and 3 of 176 liver injuries (1.7%) developed pseudoaneurysms.
- Pseudoaneurysms were associated with high-grade (III and IV) splenic and grade IV liver injuries.
- Most splenic pseudoaneurysms thrombosed spontaneously, while liver pseudoaneurysms often required intervention due to delayed hemorrhage.
Conclusions:
- Pseudoaneurysm formation is linked to high-grade blunt abdominal trauma in children.
- Routine screening before hospital discharge may be beneficial for these patients.
- Early detection and management can mitigate the risk of life-threatening hemorrhage.
Background:
Although blunt injury to the spleen and liver can lead to pseudoaneurysm formation, current surgical guidelines do not recommend follow-up imaging. Controversy exists regarding the clinical implications of these traumatic pseudoaneurysms as well as their management.
Methods:
Retrospective review of children treated nonoperatively for isolated blunt liver and spleen trauma between 1991 and 2008 was undertaken. Patient demographics, grade of injury, and follow-up Doppler ultrasound results were obtained.
Results:
Three hundred sixty-two children were identified. One hundred eighty-six of them had splenic injuries, and 10 (5.4%) developed pseudoaneurysms. They were associated with grade III (3/39 [8%]) and grade IV (7/41 [17%]) injuries. In 7 patients, the pseudoaneurysm thrombosed spontaneously. Angiographic embolization was required in 2 children, and one underwent emergency splenectomy for delayed hemorrhage. Of the 176 patients who had liver injuries, 3 (1.7%) developed pseudoaneurysms. All 3 were associated with grade IV injuries (3/11 [27%]). One child underwent early embolization, while 2 developed delayed hemorrhage requiring emergent treatment.
Conclusions:
Pseudoaneurysm development after blunt abdominal trauma is associated with high-grade splenic and liver injuries. Routine screening of this group of patients before discharge from hospital may be warranted because of the potential risk of life-threatening hemorrhage.